Managed care plans hmo - Study guides, Class notes & Summaries
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Solution and Answer Guide for Medical Assisting Administrative & Clinical Competencies (MindTap Course List) 9th Edition by Michelle Blesi Blesi, Medical Assisting
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Solution and Answer Guide for: Blesi, Medical Assisting, 2022; Chapter 01: The Medical Assistant, Health Care Team, and Medical Environment © 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1 website, in whole or in part. Solution and Answer Guide for Medical Assisting Administrative & Clinical Competencies (MindTap Course List) 9th Edition by Michelle Blesi Blesi, Medical Assisting, 2022; 9780357502815; Chapter 01: The Medical Ass...
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ANCC Risk mgt / ethics / research Exam 93 Questions with Verified Answers,100% CORRECT
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ANCC Risk mgt / ethics / research Exam 93 Questions with Verified Answers 
 
 
What are some systematic components to reducing risk? 
What does it begin with? - CORRECT ANSWER Begins with a formal written plan 
-organizational goals 
-delineation of program scope, components, methods 
-delegating responsibility for implementation and enforcement 
-commitment of the board 
-guarantees of confidentiality and immunity for those who squeal 
 
goals -> scope/methods -> delegation -> board b...
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CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers
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Steps used to control costs of managed care include: - Answer Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
DRG is used to classify - Answer Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
Identify the various types of private health plan coverage - Answer HMO 
Conventional 
PPO and POS 
HDHP/SO plans - high-deductible health plans with a s...
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CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023
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CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 
Steps used to control costs of managed care include: 
Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
 
 
DRG is used to classify 
Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
 
 
Identify the various types of private health plan coverage 
HMO 
Conventional 
PPO and POS 
H...
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CSPR - Certified Specialist Payment Rep (HFMA) Exam 2023 with Complete Solutions
- Exam (elaborations) • 18 pages • 2023
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Steps used to control costs of managed care include: - ANSWER-Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
Identify the various types of private health plan coverage - ANSWER-HMO 
Conventional 
PPO and POS 
HDHP/SO plans - high-deductible health plans with a savings...
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CSPR - Certified Specialist Payment Rep (HFMA) with A+ Verified Solutions.
- Exam (elaborations) • 17 pages • 2023
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Steps used to control costs of managed care include: correct answers Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
DRG is used to classify correct answers Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
Identify the various types of private health plan coverage correct answers HMO 
Conventional 
PPO and POS 
HDHP/SO plans - high-deductible health...
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NY Series 17-52 Questions and Answers 100% Pass
- Exam (elaborations) • 7 pages • 2023
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NY Series 17-52 Questions and Answers 100% Pass 
How many eligible employees must be included in a contributory health insurance plan? 50% 
A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, The insurance through his company is primary. 
What is the period of coverage for events such as death or divorce under COBRA? 36 months 
Twenty-five days after ...
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CSPR – Questions and Answers based on full course
- Exam (elaborations) • 12 pages • 2023
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What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 
 
ACA - ANSWER-Affordable Care Act 
 
HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. 
 
Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...
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CSPR - Certified Specialist Payment Rep (HFMA) Questions With Complete Solutions
- Exam (elaborations) • 32 pages • 2023
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Steps used to control costs of managed care include: correct answer: Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
 
DRG is used to classify correct answer: Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
 
Identify the various types of private health plan coverage correct answer: HMO 
Conventional 
PPO and POS 
HDHP/SO plans - high-deductible hea...
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NAHQ CPHQ Exam 2023 with complete solutions
- Exam (elaborations) • 46 pages • 2023
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CPQA - ANSWER-certified professional in quality assurance 
 
When did CPHQ begin to advance the profession of quality and when was the first certification administered? - ANSWER-1976; Sept 8 1984 
 
Board of Director's Quality Role - ANSWER-1. set policy 
2. financial and strategic direction 
3. quality of care 
4. goals and objectives 
5. establish quality priorities 
 
Leadership - ANSWER-ability to influence an individual or group toward achievement of a goal and includes determining the ...
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